=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366423303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK WAYNE JONES DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2005
-----------------------------------------------------
Last Update Date | 04/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2720 S WASHINGTON AVE SUITE 300
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48910-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-487-8255
-----------------------------------------------------
Fax | 517-487-2059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2720 S WASHINGTON AVE SUITE 300
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48910-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-487-8255
-----------------------------------------------------
Fax | 517-487-2059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 5101010550
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------